Provider Demographics
NPI:1003203415
Name:MACDONALD, DOUGLAS SCOTT JR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:MACDONALD
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7542
Mailing Address - Country:US
Mailing Address - Phone:203-878-5958
Mailing Address - Fax:
Practice Address - Street 1:195 PLATT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-7542
Practice Address - Country:US
Practice Address - Phone:203-878-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist